Liver Biopsy Results: Need Help?

Hello All,
I finally received my liver biopsy report and following is the Report, can someone please explain me what it means.
Thank you very much:

REPORT:
===================================================================================

Liver needle biopsy specimen with minimal portal inflammation, minimal interface hepatitis and rare foci of parenchymal necroses. Ground glass hepatocytes are not identifiable,
Trichrome stain shows portal fibrosis and fibrous septum formation.
Iron stains show no Iron deposits.
Immunostains  for HBsAG and HBcAG are in progress,
Comments: Findings are in consistent with chronic Hepatitis B with minimal activity(grade 1 of 4) and fibrous septa (stage 2 of 4)

Immunohistochemical stains: There are islands of HBsAg positive  hepatocytes with membranous  and sub-membranous expression and small number of cells with cytoplasmic HBsAG;  rare hepatocytes have HBcAG in nuclei and cyptoplasm. The findings are those of HBsAG predominance pattern with low Viral Replication.
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[stef2011]

very mild sides like diarrea (diarrhea) that gets away on its own on 4%, use of probiotics can prevent it but it is not an issue

the 1g dose looks ineffective, 1.5g or 2g is effective, if you choose higher doses you must of course monitor liver and kidney function

the pill 500mg must be taken every 12hr if 1g, every 8hrs if 1,5g and every 6hrs if 2g dose,  it must be taken with a high fat food to improve absorption.unfortunately the slow release pill is not on the market so we have to use this very complicated schedule

monitor hbsag, hbvdna at start and then every 3-6months with liver and kidney function

it is increadible you dont have fibroscan (it is available from 2004 in italy and europe), if you plan a holiday in europe you will find it in any main regional town (at least in italy)

[cajim]

Your result is G1S2, which may be regarded mild-mod but can vary from doctor to doctor.

What are your other lab results and what are your symptoms if any?

[bhagwankabanda]

Hi Cajim, I really dont have any symptoms per say about anything, yaa I had some pain on lower right side (basially the rib-cage more towards backside) but I considered it due to an accident I had it 15 years back not really on the liver but on the rib cage bone at bottom on right side where I had hit when I had my car accident.

Also not sure which lab results, I do have some lab results done sometime back:
============
OLD RESULTS:
============
HB S AG W/Reflex Conf                        REACTIVE
HB S AG

HB CORE AB, TOTAL                            REACTIVE

HEPATITIS B SURFACE AB,QL             NON-REACTIVE

HEPATITIS BE AG                                NON-REACTIVE
HB E AG        

HB E AB                                              REACTIVE

ANA IFA SCR W/REFL TITER               NEGATIVE
ANA Screen, IFA

MITOCHONDRIAL AB w/RFX                  NEGATIVE
MITOCHONDRIAL AB

HEPATITIS B VIRUS DNA, PCR
HEPATITIS B VIRUS DNA                          281412 H (REF: <29 IU/ml)
HEPATITIS B VIRUS DNA                       1,637,818 H (REF: 169 copies/ml)

[cajim]

Your ALT AST?

[bhagwankabanda]

AST                                                  29               (REF: 10-40U/L)
ALT                                                  50                (REF: 9-60U/L)

[cajim]

Sounds like you are stable but need monitoring.

[stef2011]

do monitor by fibroscan yearly, i was like you in 2002 biopsy(f2) (but alt and hbvdna lower) and since my old doctor didn t use fibroscan monitoring in 2009 i was already well eastablished cirrhosis, alt and hbvdna do not help to understand if liver is stable or going to cirrhosis
it is thought that fibrosis increase is due to oxidative stress on liver and hbv mutants more than alt hbvdna values

[bhagwankabanda]

Thank you Stefano, can you also let me know that should I start any medicines yet (if my doctor suggests) or should I continue monitoring it. Also can I continue drinking milk or I have to stop that I hope not. Appreciate your suggestion. thank you.

[stef2011]

i'd try nitazoxanide mono 4 weeks and the ntz+interferon for other 12-24 weeks if you really want to get rid of virus, if you get hbvdna and hbsag decrease make a full year of this combo and then keep using ntz until hbsag gets negative, ntz works at 1,5g daily minimum
there can be heavy sides but you can stop anytie, no resistance risks, it is very easy to see response

the other way is to keep monitoring hbvdna, alt, ultrasound and fibroscan and start therapy when damage gets to f3.do not skip monitoring especially fibroscan because biopsy can easily make mistakes and f2 can be f3 in other parts of the liver, cirrhosis can take 1 year to develop, 5 years or never develop so keep monitoring

[bhagwankabanda]

thank you Stefano, unfortunately in the USA we still dont have FIBROSCAN I asked my doctor and he said its not there, I tried in New York, California and also hospitals like Mount Sinai (New York) but they also dont have fibroscan m/cs so doctors are pushing for liver biopsy.

Also the second option you suggested does it mean no medicines just monitoring?

And also what could be the side effects of nitazoxanide? With these medicines can i continue doing my Gym and Regular food?

[stef2011]

very mild sides like diarrea (diarrhea) that gets away on its own on 4%, use of probiotics can prevent it but it is not an issue

the 1g dose looks ineffective, 1.5g or 2g is effective, if you choose higher doses you must of course monitor liver and kidney function

the pill 500mg must be taken every 12hr if 1g, every 8hrs if 1,5g and every 6hrs if 2g dose,  it must be taken with a high fat food to improve absorption.unfortunately the slow release pill is not on the market so we have to use this very complicated schedule

monitor hbsag, hbvdna at start and then every 3-6months with liver and kidney function

it is increadible you dont have fibroscan (it is available from 2004 in italy and europe), if you plan a holiday in europe you will find it in any main regional town (at least in italy)

[stef2011]

researchers have it in US but i am not sure if open for anybody, see this post on hcv community

http://www.medhelp.org/posts/Hepatitis-C/Updates-and-locations-of-Fibroscan/show/1314835

do not consider the comments, biopsy can make much more errors than fibroscan so comparing the 2 can be even stupid since nor biopsy or fibroscan are 100% accurate on staging but since fibroscan can be made as much times as you want it is much more accurate on cirrhosis reaching 95%
it cannot stage correctly stage 2 and 3 but what matters is stage 3-4 and much less the others plus you cannot monitor liver by biopsies monthly during therapy

[stef2011]

other posts

http://www.medhelp.org/posts/Hepatitis-C/Fibroscan-in-NYC/show/1126883

http://www.medhelp.org/posts/Hepatitis-C/FibroScan--where-/show/1018278

[bhagwankabanda]

Thank you very much Stefano, appreciate your detailed response as always.